Stroke systems of care essential to reducing deaths, disabilities

The systems should quickly and appropriately address patients' needs from when stroke symptoms appear and EMS is called, during transport to and treatment in the hospital and through rehabilitation.

Several key elements in systems of care can reduce stroke deaths and disabilities, according to a new American Heart Association/American Stroke Association policy statement published in its journal Stroke.

Stroke is the number four cause of death and a leading cause of adult disability in the United States. On average, every 4 minutes someone dies of a stroke.

The policy statement addresses patients' care from the time stroke symptoms are identified, to the emergency medical services' (EMS) response, to the transport and treatment in the hospital and rehabilitation.

Recommendations include:

• Develop public education programs to improve awareness of stroke symptoms and the need to call 9-1-1 to get to the hospital quickly for treatment.
• Ensure EMS personnel can quickly assess stroke patients and get them to the hospital with appropriate care within 15-20 minutes.
• Establish protocols to optimize the transfer of patients between hospitals offering different levels of care and within the different departments of a hospital.
• Support the certification of stroke centers that follow treatment guidelines designed to improve patient care and outcomes.
• Use telemedicine, especially in rural areas, to ensure patients have 24/7 access to consultation and care.

The association also calls for patients to have access to post-stroke care, including rehabilitation and nursing services, regardless of their financial status or socio-economic background.

Authors of the statement also address issues related to adequate reimbursement for stroke treatment and care and the need for quality improvement and public reporting initiatives.